Use of condoms as blade covers during laryngoscopy, a method to reduce possible cross infection among patients

Pattern of anaesthetic equipment contamination and infection prevention in anaesthesia practice at university hospitals

BACKGROUND AND AIMS

Infection control is essential in anaesthetic practice for both personnel and equipment used. This study aims to evaluate knowledge of anaesthesiologists about infection control practices and to detect the pattern of anaesthetic devices contamination.

METHODS

Cross-sectional observational study at two university hospitals was done. Self-administered questionnaires were distributed to 80 anaesthesiologists and 90 nursing staff. Forty-four samples were taken from rigid laryngoscopes (22 pairs from handle and blade) for detection of bacterial or fungal contamination. Same laryngoscopes were tested for occult blood.

RESULTS

The response rate among the physicians was 72% while for nurses 94.4%. The responses were variable reflecting lack of adequate knowledge and unsatisfactory compliance to infection control practices. Tested samples showed no fungal growth. Fourteen (31.8%) samples were negative for bacteriological contamination and 5/44 (11.4%) showed gram-positive bacilli; gram-positive cocci were isolated from 12 samples (27.3%) where Staphylococcus epidermidis and Staphylococcus aureus, respectively, shared 18.2% and 9.1% of the total samples. Gram-negative bacilli were isolated from 13 samples (29.5%), of which Klebsiella spp. were most frequent (11.4%). Both Pseudomonas aeruginosa and Acinetobacter baumannii were isolated from 6.8% each. Citerobacter spp. was isolated from 4.5%. Occult blood was found in 45.5% of samples.

CONCLUSION

The current study showed contamination of ready-to-use laryngoscopes in operative theatres and ICUs.

Laryngoscope decontamination techniques: A survey

Background and Aims:

India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India.

Material and Methods:

An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire.

Results:

A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution.

Conclusion:

There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.

Pediatric laryngoscopes and intubation aids old and new

This review summarizes the evolution of the pediatric laryngoscope using some of the established landmarks in the history of anesthesia. Children were rarely intubated before 1940 though the subsequent 30 years saw a proliferation of pediatric laryngoscopes in part driven by the developments in pediatric anesthesia and surgery, manufacturing techniques and materials and a change in airway management philosophy exemplified by Jackson Rees's argument against the notion that intubation was to be avoided in children. A perspective on the present day describes the modifications to popular straight and curved blade laryngoscopes and the development of new devices that enhance direct visualization of the larynx. There are an ever-increasing number of laryngoscope devices that assist in indirect visualization of the larynx such as rigid optical stylets and flexible fiber-optic scopes. Images from many of these devices may be enhanced by digital camera or real-time video technology. The prospect of future laryngoscope development is glimpsed in the arrival of light emitting diode light source technology and questions remain regarding the consequences of equipment disposability and at the fidelity of disposable equipment manufacture.

Prevention of disease transmission during flexible laryngoscopy

The medical literature was reviewed to evaluate the risk of disease transmission and nosocomial infection associated with flexible laryngoscopes. These instruments have been reported to be contaminated with blood, body fluids, organic debris, and potentially pathogenic microorganisms during routine clinical use. Failure to reprocess properly a flexible laryngoscope may, therefore, result in patient-to-patient disease transmission. Different types of biocidal agents, including 70% isopropyl alcohol, quaternary ammonium compounds, and 2% glutaraldehyde have been reported to be used to disinfect flexible laryngoscopes. A logic, or algorithm, was developed to evaluate the adequacy of these and other types of biocidal agents used during instrument reprocessing. This review determined that flexible laryngoscopes are semicritical instruments that require high-level disinfection (or sterilization) to prevent nosocomial infection. Whereas 70% isopropyl alcohol, quaternary ammonium compounds, and other products that achieve intermediate-level or low-level disinfection are contraindicated for reprocessing flexible laryngoscopes, 2% glutaraldehyde and other products that achieve high-level disinfection (or sterilization) are recommended for reprocessing these instruments to prevent nosocomial infection. A formal set of step-by-step guidelines for reprocessing flexible laryngoscopes is provided. Use of a disposable sheath to cover and protect the flexible laryngoscope from contamination during clinical use is discussed.

User satisfaction and forces generated during laryngoscopy using disposable Miller blades: a manikin study

Increasing awareness of prion-related diseases has led to an increase in the number of disposable laryngoscope blades available. We compared 11 disposable and standard re-usable Miller size 1 blades. In this manikin-based study, we studied user satisfaction for field of view at laryngoscopy, build quality and users' willingness to use the blade in an emergency situation. These were found to be better with metal disposable blades (p</=0.001). Vertical and horizontal forces developed during laryngoscopy were greater with plastic than with metal blades.

Recommendations to resolve inconsistent guidelines for the reprocessing of sheathed and unsheathed rigid laryngoscopes

Neither a consensus statement nor a formal set of step-by-step guidelines for reprocessing rigid laryngoscopes have been published or endorsed by professional organizations. Several published guidelines, standards, and clinical reports were reviewed to evaluate the risk of nosocomial infection associated with the use of rigid laryngoscopes, to determine their minimum reprocessing requirements. This review found that the recommendations of some guidelines and standards for reprocessing rigid laryngoscopes are incomplete, inadequate, and inconsistent with one another, and that current practices for reprocessing rigid laryngoscopes are reported to be inadequate and lack standardization. It is recommended that a consensus statement be developed that standardizes the reprocessing of rigid laryngoscopes and requires cleaning followed by high-level disinfection (or sterilization) and drying of the rigid laryngoscope's blade and handle to prevent nosocomial infection, regardless of whether a protective barrier or sheath is used during the procedure.